A Relationship + Low AMH: Deciding Between Freezing Eggs or Embryos

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It’s only when a new situation presents itself that you realize just how unprepared you really are. Wouldn’t it have been nice if a high school class taught us about 401K investments, or what to do when you get food poisoning in Peru? Or it would have been really great if I had learned anything in my lifetime about fertility, particularly before getting my diagnosis of Diminished Ovarian Reserve (DOR) at the age of 31.

I had been in a committed relationship for eight and a half years before learning I had DOR, but that doesn't mean this diagnosis made me or my boyfriend suddenly ready to be parents. In fact, it may have done the opposite. We hadn’t yet discussed if or when we were going to have kids - we were still trying to discuss marriage, our careers and what city we might end up in. But my 0.45 AMH was grim, and our options were medical intervention or straight up, natural trial-and-error to gauge just how bad it really was.

After careful consideration of these paths and a whole lot of crying, I realized trying to get pregnant immediately was not the right answer for me. I hadn't decided if I wanted children at all, and I couldn’t now make that decision under the extreme and sudden pressure I was experiencing. I also knew, however, that I couldn't live with myself if I gave up the opportunity to ever have kids. There was only one thing for certain: I needed more time.

I dove into the options. Research suggested my chances would be more successful if this was a "joint venture" and my boyfriend and I created and saved embryos, versus freezing my eggs alone. So that's what we agreed. But we made this extremely important decision in between his crazy travel schedule, while I was navigating a new job, and with an unfortunate series of half-conversations. We reviewed pricing over and over again, and while he was on the other side of our country, I charged my credit card.

When it came time to go over the details in person, however, he froze. He wasn’t ready for this choice and felt rushed. I on the other hand, felt like he just took away any chance I had at a successful pregnancy. We had this conversation on my way to work – a car ride that is unforgettable in the most painful way. I cancelled the embryo freezing, received a refund like I was returning a pair of shoes, and walked into my office. Just like that, I had nothing again.

But I started to see what my boyfriend might be thinking. This is not the type of decision you can make unless you’re 100% sure and 100% ready, which is a deceptively easy thing to say. In reality, it means knowing exactly what would happen if we separated. Do we sign legal agreements that I could still use our embryos? Would I still want to use those embryos if I hated him? But then if I didn't use them, would I have no other option for a baby? Where would we even start in drafting an agreement? Did we have the time to find a lawyer? I started to forgive him for that car ride.

So I signed the metaphorical pre-nup. I made the choice to only freeze my eggs. I was nervous that I might only get a few eggs, and that I’d lower my chances for success even further if I didn’t fertilize those eggs immediately. Those are unknowns that ultimately didn’t define how I made this decision. But it did define what happened next.

What it came down to was my uncertainty that this man is ready for any of this: marriage, babies and the like. And I needed to make sure I was doing everything I could to preserve all of my options for the future. A future that may or may not include him. While even though I wish with everything in me that we’ll remain together, I couldn’t bind us with something so important to both our futures. This is literally our DNA. What’s more permanent than that? And it was because of his decision to take back his offer that led me to the conclusion that not only could we not make the future commitment of our DNA, we hadn't even made the present commitment to each other. His refusal to participate in embryo creation launched a set of year-long conversations about our future together as a couple, for which I'm grateful and exhausted.

But the truth is even if my boyfriend and I were perfectly happy with no relationship issues to speak of — does that even exist for any couple? — I hope I would have still chosen to freeze my eggs instead of embryos. Because while it isn't easy, and at times I even felt guilty, like I was removing him from the equation, this was a medical issue brewing inside my body, forcing my hand. These eggs are mine, and only I can decide what to do with them, when the time that I need comes. The idea of then linking that power to another person feels like I would have been giving up that control. I would have been sacrificing all of my own possibilities in order to provide our relationship flexibility. I’d like to think I would have realized I deserve better.

So now, at a time when women’s choices over their bodies has never been more relevant, I couldn’t feel more right about this decision. When I think of these events, I feel empowered, brave, and most importantly, it feels right.

And suddenly - figuring out how to invest in my 401K seems really, really easy.

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Expert's Perspective

Jacque Cohen, PhD

Laboratory Director at Walter Reed National Military Medical Center (NIH)